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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592637
Report Date: 02/13/2024
Date Signed: 02/13/2024 04:24:17 PM

Document Has Been Signed on 02/13/2024 04:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ADULT BASIC LEARNING ENVIRONMENT, INC.FACILITY NUMBER:
191592637
ADMINISTRATOR:MIRIAM CUEVASFACILITY TYPE:
775
ADDRESS:452 W. BADILLO ST.TELEPHONE:
(626) 858-5267
CITY:COVINASTATE: CAZIP CODE:
91723
CAPACITY: 30CENSUS: 12DATE:
02/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:48 PM
MET WITH:Miriam Cuevas TIME COMPLETED:
04:35 PM
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Licensing Program Analyst (LPA) Wong conducted the required annual inspection on today's date. LPA arrived unannounced and met with Program Director Miriam Cuevas. The day program is licensed to serve a capacity of 30 participants, ages 18 through 59, 13 wheelchairs permitted only.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools and inspected the following domains:

Infection Control: Staff are using appropriate hand hygiene and wearing gloves when necessary to assist participants. Staff are cleaning and disinfecting daily. Facility keeps a sufficient amount of PPE supplies at the site.

Physical Plant and Environmental Safety: The facility includes: Main room, storage room, relaxation room, program director office, changing room, kitchen, three clients' bathrooms, art room and vocational room and a front outside patio. The facility is clean, safe and in a good working condition. LPA tested the hot water temperature in all three bathrooms and they were in between 107 and 110 degrees F which is within the Title 22 regulation. All the cleaning supplies are stored and locked in the storage room. The facility stated that the client would bring their own lunch to the facility and facility would provide clients with snacks if needed. The facility does have drinking water available in the kitchen for clients. The outdoor activity space and passageway are free of obstruction and hazards. LPA also inspected the carbon monoxide detectors mounted on the wall in the main room and is working well.

Operational Requirement: The facility is licensed for 30 participants and currently the facility has 12 participants and 4 participants are on wheelchair.

Staffing: The staffing in the facility is sufficient and their client staff ratio is three to one which is the regional center requirement.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC.
FACILITY NUMBER: 191592637
VISIT DATE: 02/13/2024
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Personnel Records: The staff files are stored in the file cabinet in the program director office. All the staff in the facility is fingerprint, background check cleared and associated with the facility. LPA inspected two staff files and they all have the required documents included the health screening and TB test result. Administrator received required hours for the continue education for every two years of employment. Staff#1 does not have required training hours on file.

Client record and Incident Reports: The client files are stored in the file cabinet in the program director office. LPA reviewed two clients files, they all have the required documents in the client's files which included: Admission Agreement, Face sheet, Needs and Services/Individual Program Plan, Functional Capacity Assessment, Physician Report and TB test result.

Client's right: Currently the facility does not have any clients that required postural support.

Food Service: Participants bring their own meals and snacks daily to the program. Perishable items can be stored in the refrigerator. Facility has snacks available for clients if needed. All the food are stored properly in the kitchen. All the toxic substances and food are stored separately.

Health Related Services: The facility currently does not have any client that required medication administration. All the staff has an updated first aid and CPR certificate. The facility does not have the Automated External Defibrillators (AED) available in the facility. The facility does accept client with bladder or bowel incontinence and the day program is free of odor and they are able to ensure the client kept clean and dry.

Incidental Medical Services: There are no clients who require health services or have a health condition that need to be monitored more carefully.

Disaster Preparedness: The facility has an Updated Emergency Disaster Plan dated on 8/1/23 posted with contact numbers and at least 2 relocation sites. Emergency procedures are explained on the disaster plan. The last fire drill was conducted on 1/18/2024 and earthquake drill was conducted on 1/30/2024. The facility conducted the drill monthly,

Emergency Intervention: Facility does not use any restraints on clients.

Per California Code of Regulations, Title 22 Division 6, Chapter 8, Type B deficiency was observed and is being cited today in violation of California Code of Regulations.

Exit Interview Conducted and a copy of the report and appeal right was provided to Program Director Miriam Cuevas.

(During the inspection, LPA was not able to interview any staff and clients as they all left from the program)





SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christine Wong
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2024
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Document Has Been Signed on 02/13/2024 04:24 PM - It Cannot Be Edited


Created By: Christine Wong On 02/13/2024 at 03:58 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ADULT BASIC LEARNING ENVIRONMENT, INC.
FACILITY NUMBER: 191592637

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065.1(d)(1)
Personnel Qualifications and Duties
(1) Direct care staff shall receive a minimum of 8 hours a year of training, documented.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA reviewed Staff# files and does not have the complete initial trianing horus which posed the potential risk to residnets in care.
POC Due Date: 02/27/2024
Plan of Correction
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The administrator will send the copy of S1 complete the initial trianing hours to LPA by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:David Sicairos
LICENSING EVALUATOR NAME:Christine Wong
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024


LIC809 (FAS) - (06/04)
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